NURS-1094EL Lecture Notes - Lecture 6: Pulmonary Valve, Pulmonary Insufficiency, Tricuspid Valve
Cardiovascular System Assessment
Health History
1. Any chest pain or tightness?
2. Any shortness of breath?
3. Use more than 1 pillow to sleep?
4. Do you have a cough?
5. Do you seem to tire easily?
6. Facial skin ever turn blue or ashen?
7. Awaken at night to urinate?
8. Any leg pain or (cramps)? Where?
9. Any skin changes in arms or legs?
10. Any sores or lesions in arms & legs?
11. Any swelling in the legs?
12. Any swollen glands? Where?
Physical Examination
1. Inspect & Palpate Carotid Arteries
1. Grade: Right & Left
• 0 = absent, 1+ weak, 2+ normal, 3+ increased, 4+ bounding
• Listen for presence of bruits (blowing, swishing sound indicating blood flow turbulence)
o Normally none is present
• Apply bell of stethoscope over carotid artery at 3 levels;
o Angle of jaw, mid-cervical area, base of neck
• Ask the patient to take a breath, exhale, & hold without breathing while you listen so that tracheal breath
sounds do not mask or mimic a carotid artery bruit
• Palpate each carotid artery medial to the sternomastoid muscle in the neck (symmetrical)
o Avoid excessive pressure on the carotid sinus area higher in the neck
o Feel contour (smooth with a rapid upstroke & slower downstroke) & amplitude (strength is 2+/moderate)
2. Inspect & Palpate Precordium
1. Skin Colour & Condition
2. Chest Wall Pulsations
• Using palmar aspects of your 4 fingers, gently palpate over the apex, the left sternal border, & the base,
searching for any other pulsations (none should be present)
• Thrill = palpable vibration (signifies turbulent blood flow & accompanies loud murmurs)
3. Heave or Lift
• Sustained forceful thrusting of the ventricle during systole (eg. Increased workload)
4. Apical Impulse (Point of Maximal Impulse) in the 4th/5th interspace at the mid-clavicular line
• Size: 1x2 cm & Amplitude: short, gentle tap
3. Auscultation
1. Identify Anatomical Areas where you will listen 4 traditioal valve areas
• Aortic valve area (2nd right interspace)
• Pulmonic valve area (2nd left interspace)
• Tricuspid valve area (5th intercostal space at left lower sternal border)
• Mitral valve area (5th interspace at approx. left mid-clavicular line)
2. Rate & Rhythm
• 60-100 beats per minute
• Regular (sinus arrhythmia is normal & increases at the peak of inspiration & slowing with expiration)
3. Identify S1 & S2 & Note any Variations
• S1: start of systole & louder at apex (coincides with carotid artery pulse)
o Caused by closure of the AV valves
• S2: start of diastole & louder at base
o Caused by closure of the semilunar valves
4. Listen in Systole & Diastole
• Extra Heart Sounds
o Split S1: heard in tricuspid valve area
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Document Summary
Inspect & palpate carotid arteries: grade: right & left. 0 = absent, 1+ weak, 2+ normal, 3+ increased, 4+ bounding. Palpate each carotid artery medial to the sternomastoid muscle in the neck (symmetrical: avoid excessive pressure on the carotid sinus area higher in the neck. Feel contour (smooth with a rapid upstroke & slower downstroke) & amplitude (strength is 2+/moderate) Thrill = palpable vibration (signifies turbulent blood flow & accompanies loud murmurs: heave or lift. Sustained forceful thrusting of the ventricle during systole (eg. increased workload: apical impulse (point of maximal impulse) in the 4th/5th interspace at the mid-clavicular line. Size: 1x2 cm & amplitude: short, gentle tap: auscultation. Identify anatomical areas where you will listen (cid:894)4 traditio(cid:374)al valve (cid:862)areas(cid:863)(cid:895: aortic valve area (2nd right interspace, mitral valve area (5th interspace at approx. left mid-clavicular line) Tricuspid valve area (5th intercostal space at left lower sternal border: rate & rhythm.